Department of Surgery, Center for Trauma and Critical Care, George Washington University, Washington, District of Columbia.
Department of Surgery, Center for Trauma and Critical Care, George Washington University, Washington, District of Columbia.
J Surg Res. 2024 Jan;293:427-432. doi: 10.1016/j.jss.2023.09.016. Epub 2023 Oct 7.
Patients who undergo exploratory laparotomy (EL) in an emergent setting are at higher risk for surgical site infections (SSIs) compared to the elective setting. Packaged Food and Drug Administration-approved 0.05% chlorhexidine gluconate (CHG) irrigation solution reduces SSI rates in nonemergency settings. We hypothesize that the use of 0.05% CHG irrigation solution prior to closure of emergent EL incisions will be associated with lower rates of superficial SSI and allows for increased rates of primary skin closure.
A retrospective observational study of all emergent EL whose subcutaneous tissue were irrigated with 0.05% CHG solution to achieve primary wound closure from March 2021 to June 2022 were performed. Patients with active soft-tissue infection of the abdominal wall were excluded. Our primary outcome is rate of primary skin closure following laparotomy. Descriptive statistics, including t-test and chi-square test, were used to compare groups as appropriate. A P value <0.05 was statistically significant.
Sixty-six patients with a median age of 51 y (18-92 y) underwent emergent EL. Primary wound closure is achieved in 98.5% of patients (65/66). Bedside removal of some staples and conversion to wet-to-dry packing changes was required in 27.3% of patients (18/66). We found that most of these were due to fat necrosis. We report no cases of fascial dehiscence.
In patients undergoing EL, intraoperative irrigation of the subcutaneous tissue with 0.05% CHG solution is a viable option for primary skin closure. Further studies are needed to prospectively evaluate our findings.
与择期手术相比，在紧急情况下接受剖腹探查术（EL）的患者发生手术部位感染（SSI）的风险更高。包装好的食品和药物管理局批准的 0.05%葡萄糖酸氯己定（CHG）灌洗液可降低非紧急情况下的 SSI 发生率。我们假设在紧急 EL 切口关闭前使用 0.05%CHG 灌洗液冲洗，将与较低的浅表 SSI 发生率相关，并允许更高的原发性皮肤闭合率。
对 2021 年 3 月至 2022 年 6 月期间所有接受 0.05%CHG 溶液冲洗皮下组织以实现剖腹手术后原发性伤口闭合的紧急 EL 患者进行回顾性观察性研究。排除腹壁有活动性软组织感染的患者。我们的主要结局是手术后原发性皮肤闭合率。适当使用描述性统计，包括 t 检验和卡方检验来比较组间差异。P 值<0.05 为统计学显著。
66 例患者的中位年龄为 51 岁（18-92 岁），接受了紧急 EL。98.5%（65/66）的患者实现了原发性伤口闭合。27.3%（18/66）的患者需要床边移除一些订书钉并转换为湿至干包装。我们发现这些主要是由于脂肪坏死。我们没有报告筋膜裂开的病例。
在接受 EL 的患者中，术中用 0.05%CHG 溶液冲洗皮下组织是一种可行的选择，可实现原发性皮肤闭合。需要进一步前瞻性研究来评估我们的发现。
